Some Basic Reforms For Medicaid

January 21, 1994

It will take more than a few administrative changes to cure what ails Illinois' chaotic Medicaid system, but some common-sense reforms recently introduced in the General Assembly would make a good start.

A bipartisan group of 19 state senators has sponsored legislation that aims at four of the worst abuses uncovered by last autumn's Tribune series "Medicaid: System in Chaos."

The legislation would require that:

- a photograph of the recipient be affixed to each Medicaid eligibility card;

- pharmacists billing Medicaid provide the name of the prescribing physician;

- reimbursement requests include the name of both the care provider and the recipient.

One might reasonably ask how the Illinois Department of Public Aid could issue Medicaid reimbursement checks without knowing the identity of the patient, the diagnosis or the provider/physician?

But anyone who read the Tribune series knows there's not much "reasonable" about Illinois' $4.2 billion Medicaid program, the cost of which has risen 48-fold in 26 years. Reporters, for instance, tracked patients who spend their days roaming from clinic to clinic collecting prescription drugs. One logged 426 physician visits in a single year, costing taxpayers more than $100,000 in drugs and doctors' bills.

In reaction, the state has announced it will double the size of its utilization review staff in order to catch more cheating patients, doctors and pharmacists. And a state task force has been convened by Senate Democratic Leader Emil Jones to explore other needed reforms.

It will require more than better policing, however, to straighten out what's wrong with Medicaid. The entire program needs to be re-evaluated as part of national health reform.

One promising way to cut costs and boost quality would be to enroll recipient families in managed-care programs such as health maintenance organizations (HMOs).

And the federal government, which sets the rules, needs to reconsider Medicaid coverage of nursing home care, a commitment that has steadily drained funds from maternal and pediatric care.

But in the meantime, before Medicaid is allowed to destroy the state budget, Illinois can at least get on top of who's being treated, for what, by whom and at what cost.